Vacant Residential Property Registration Form

2. Division of Rental Inspections
   333 S. Tanner St. Room 402 Rantoul, IL 61866 Office Ph:(217)892-6804 Fax:(217)892-5501

   333 S. Tanner St. Room 402 Rantoul, IL 61866 Office Ph:(217)892-6804 Fax:(217)892-5501

4. Property Address

6. City

7. State

8. Zip

10. Tax ID / Parcel #

11. Today's Date

13. Check all that apply:

    1. Rental
    2. For Sale

    1. Foreclosure

    1. Rehab

    1. Other

15. If "other", please describe.

17. Name(s) of Legal Owner(s)

19. Mailing Address

21. City

22. State

23. Zip

25. Contact Information

    Email or Phone

27. Property Manager

29. Mailing Address

31. City

32. State

33. Zip

35. Contact Information

    Email or Phone

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field